Krystal Kelly, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

004885 Issued in CT

Practice address

1 Regency Dr Ste 101
Bloomfield, CT 06002-2310

Phone

(860) 905-4776

NPI assigned

Nov 6, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grace Valley Clinical Services

  • Professional Counselor
  • Windsor, CT
  • NPI 1841926045
  NPD Authorized official
• Community Matters Outpatient Psychiatric Clinic for Children, Inc.

  • Community/Behavioral Health Agency
  • East Hartford, CT
  • NPI 1295336329
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783036800000",
    "number": "1821753658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 HOLMES DR",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060953969",
            "telephone_number": "860-778-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 REGENCY DR STE 101",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022310",
            "telephone_number": "860-905-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KRYSTAL",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-06",
        "last_updated": "2026-07-03",
        "certification_date": "2026-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CT",
            "license": "004885",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "004885",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "004885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alona Kantorovich, MD
• Joan Marie Karpuk, P.T.
• Herbert J Keating III, MD
• Roy A Kellerman, MD
• Taylor Kelley
• Evan Kennedy, PT
• Maham Khan, RPH
• Rebecca L Kilpatrick, APRN
• Chulhwan J Kim, DMD
• Diane Kleska, PT

• Professional Counselor in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.